Laserfiche WebLink
1 <br /> WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-6232(209)468-3420 <br /> NON-REFUNDABLE PERMIT www.sjgov.org/ehd EXPIRES 1 YEAR FROM DATE ISSUED <br /> Ul <br /> JOB ADDRESS 16286 W.Schulte RoadCITyZP Tracy/95377 6m <br /> CROSS STREET Hansen Road APN 20949@,Q 304.5'PARCEL SIZE 18.66 LAND USE APPLICATION# o <br /> OWNER NAME David Pombo david.pombo.reattor@gmgail.ccoojm D;D POMbD a(- PHONE 209.835.4949 <br /> OWNER ADDRESS Pombo Real Estate,I�PS/Sd AOlnsPn CITY/STATE/ZIP Tracy,CA 9537/!700 <br /> rn <br /> tJ <br /> CONTRACTOR V&W Drilling-Contact:Karli Stroing PHONE 209.981.7755 <br /> Ca <br /> C <br /> CONTRACTOR ADDRESS 1133 Blackhurst Drive CITYISTATEIZIP Galt,CA 95632 <br /> n <br /> SUBCONTRACTOR/CONSULTANT Condor Earth Technologies,Inc.-Contact:Chad Borean PHONE 209.601.1430(cell) <br /> C <br /> iD <br /> SUBCONTRACTORICONSULTANT ADDRESS 188 Frank West Circic,Suite I CITYISTATE/ZIP Stockton,CA 95206 0 <br /> an <br /> LICENSE X C-57 C-61 D-09 Other NUMBER 720904 EXPIRATION DATE 04/30/2022 <br /> �-1 <br /> BILLING PARTY: OWNER CONTRACTOR X SUBCONTRACTOR/CONSULTANT <br /> DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392) Arsenic(4393) <br /> INTENDED USE Domestic/Private Irrigation/Agricultural Industrial Water Quality Monitoring Soil Sampling/Characterization <br /> Public Water System <br /> If different from O"ec Water System Name Contact Name or Phone Number <br /> TYPE OF WORK New Well Replacement Well Well Alteration/Modification Other <br /> Monitoring Well(s) #of wells Soil Boring(s) #of b0/111gs X Geotechnical 4 #of borings <br /> Out-Of-Service Well Out-Of-Service Well Renewal Cross-Connection Repair <br /> New Pump Pump Replacement Pump Repair Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method Mud Rotary Air Rotary X Auger Cable Toot Push Point Other <br /> Proposed Well Depth 15 to 25 it Excavation 4 1/2 in diameter Open Bottom Gravel Pack/Gravel Size in diameter <br /> Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter_in Thickness/Gauge/ASTM Sched Steel Plastic Stainless Steel Other <br /> Grout Seal Depth full depth It X Neat Cement(94 lb bag/5-10 gal water) Sand Cement sack mix17 gal water <br /> Bentonite(20%solids) Other <br /> Grout Placement Method Pumped Free Fall X Other Tremie Retardant/Accelerator(name) <br /> PEDESTAL Installed By Driller Pump Contractor Other <br /> Concrete Pedestal Dimensions:Width ft Length ft Thick in Christy Box Stove Pipe <br /> PUMP Submersible Turbine Other HP Pump Set it Standing Water Level ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> MINIM(' OUR�rBy N NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE Project Coordinator DATE 11/09/20 <br /> L, <br /> LL <br /> i�#IE 1 1 1 1 1 1 <br /> / DEPARTMENT USE ONLY <br /> Application Accepted By `'Z- Date I) 1'0 Area j' G� Employee ID# R•/� <br /> f6 <br /> Grout Inspection By L Date It SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By Date Constructed Well Depth ft <br /> COM NTS O o ^ <br /> PE SC Received Check#/ Amount Permit/ / LY <br /> Codes Info B Cash Remitted a Servic Re u st# Invoice# Wel # l pFj yvvt <br /> 37 SOLb i&.jL- M112 <br /> EHD43-06 6111/2019 WELL(PUMP PERMIT <br />